Dying matters: medicolegal aspects of end-of-life care, DNACPR and organ donation

To mark the Dying Matters national awareness week, between 13 and 19 May, Medical Protection asked nearly 400 members in the UK about their experiences on a number of issues such as DNACPR, organ donation and withdrawal of treatment.

The survey found that 72% of respondents do not feel they have adequate time to discuss end of life care with their patients, while only just over half (55%) of respondents feel comfortable discussing dying with their patients.

You can read our articles on the importance of communication in end-of-life care and with families following a patient’s death.

Other notable findings were:

• 31% of respondents said they were not particularly confident in discussing organ donation with patients – read our article for more on this topic
• 67% felt “very confident” that they understand the DNACPR process
• 62% did not feel that patients understood the DNACPR process
• 58% felt “very confident” that they understand the legal and ethical issues around withdrawal of treatment – read more on a key Supreme Court ruling in 2018
• 28% did not feel confident that they understand the legal and ethical issues around withdrawal of nutrition and hydration.

Disagreements over decisions relating to DNACPR were also reported by 39% of respondents. In situations where a patient at the end of life lacked capacity to make a decision on DNACPR, respondents commented widely on challenging discussions with the families, with comments including:

• “Multiple meetings with family members, senior staff and palliative care. There remained difficulty in the family’s understanding, despite a terminal diagnosis months beforehand, and the situation was frequently hostile. Ultimately, family and staff remained civil but had very different opinions.”
• “Patient got intubation and spent three months in intensive care before dying and the grandmother then tried to say the doctors had killed her.”
• “Eventual discussion with family led to DNACPR being confirmed. Management from medical team was muddled – the consultant was unsure whether to leave DNACPR in while family were disputing it, despite it being the medical decision and the family were informed promptly of the original decision.”

The survey also asked members whether the risk of death – no matter how small – should always be mentioned as part of the consent process. While 30% of respondents said they “strongly agreed”, a notable 29% did not agree. You can read our article which covers this topic in more detail.

Ultimately what the survey shows is that even where doctors feel comfortable discussing end of life with their patients, time constraints can mean that they often don’t feel able to have these discussions.

Further reading:

Understanding mental capacity: advance decisions – A patient’s capacity to make decisions about their own care is a fundamental part of matters relating to end of life care.

Giving evidence at an inquest – As a doctor, you may be asked to give evidence at an inquest, which is conducted by the coroner and, in some cases, in front of a jury. The purpose of an inquest is to find out who died – when, where, how and in what circumstances.

The procurator fiscal and fatal accident inquiries – A procurator fiscal investigates all sudden and suspicious deaths in Scotland, conducts fatal accident inquiries and handles criminal complaints against the police.

Confidentiality after death – Confidentiality is at the centre of maintaining trust between patients and doctors. But what are your obligations to a patient after they have died?